CCRN EXAM

A 59 year old male is admitted complain￾ing of chest pain and dyspnea. ST eleva￾tion and T wave inversion were seen on the EKG inV2,V3 andV4. IV thrombolytic therapy was started in ED. Indications of successful reperfusion would include all of the following except: (A) pain cessation (B) decrease in CK or troponin (C) reversal of ST segment elevation with return to baseline (D) short runs of ventricular tachycardia Which of the following medication orders should the nurse question for the patient in question 1-reperfusion question-pa￾tient having an MI? (A) metoprolol (Lopressor) (B) aspirin (C) propranolol (Inderal) (D) heparin If heart block develops while caring for the patient in question 1 (pt with an MI who went through reperfusion from PCI or fibrinolytic therapy), which of the fol￾lowing would it most likely be? (A) sinoatrial block (B) second degree, Type I (C) second degree, Type II (D) third degree, complete (B)Coronary artery reperfusion due to PCI or fibrinolysis results in an ELEVA- TION of creatinine kinase (CK) or tro- ponin, not decrease. The theory is that the return of blood flow distal to the oc- clusion can result in 'reperfusion injury' of the muscle, elevating cardiac biomark- ers. The other 3 choices are indicators of reperfusion: Pain cessation, reversal of ST segment elevation with return to baseline, short runs of ventricular tachy- cardia. (C) The patient in the scenario is having an acute anterior wall MI. A beta blocker is beneficial for an acute MI as these agents decrease the work of the heart and increase the threshold for ventric- ular fibrillation. Propranolol, although a beta-andrenergic blocker like metoprolol, is NOT a cardioselective beta blocker. It affects beta receptors in heart muscle AND lung tissue. Therefore, it is more likely to cause bronchoconstriction than a cardioselective beta blocker. The other 3- cardioselective beta blocker, antiplatelet, and anticoagulation-are indi- cated in an acute MI. (C) The patient is having an acute anteri- or MI, which is generally due to LAD oc- clusion. The LAD supplies the HIS bun- dle, which could result in a second-de- gree, type II heart block. The other 3 types are due to SA node or AV node ischemia, which generally occur with an RCA occlusion — interior wall MI. CCRN EXAM 2 / 14 Appropriate drug therapy for dilated car- diomyopathy is aimed toward: (A) decreasing contractility and decreasing preload and afterload (B) decreasing contractility and increasing preload and afterload (C) increasing contractility and increasing both preload and afterload (D) increasing contractility and decreasing both preload and afterload An 18 year old is admitted with a history of syncopal episode at the mall and has a history of an eating disorder.The nurse notes a prolonged QT on the 12-lead EKG and anticipates a reduction in an electrolyte to be the cause. Which of the following is LEAST likely to cause this patient's problems? (A) sodium (B) magnesium (C) potassium (D) calcium On the third day after admission for acute MI, a 67 year old male complains of chest pain and develops a fever.The pain is worse with deep inspiration and is relieved when he leans forward. There are nonspecific ST changes in the precordial leads of the EKG. The nurse anticipates that the patient will most likely need treat- ment for: (A) thoracic aneurysm (B) Dressler's syndrome (C) reinfarction (D) pleuritis A patient is admitted to the CCU after a PCI with stent. Femoral sheath is in place, site is dry with no hematoma. He (D) Dilated cardiomyopathy is likely to result in systolic dysfunction, which de- creases contractility, causes compen- satory arterial constriction , and results in a higher left ventricular preload. To treat this, therapy is aimed at increasing contractility, decreasing afterload (arterial constriction), and decreasing preload that is too high.